Hot flushes

‘Is it hot in here?’ What you need to know about hot flushes in menopause

Hot flushes (also known as hot flashes) are one of the most common and recognisable symptoms of the menopause transition. They affect up to 80% of women, they often start during perimenopause and continue for years after the last period. Despite how common, disruptive, and exhausting they can be especially when they interfere with sleep or daily life many women with moderate to severe symtoms will not seek support.[1]

This article explains what causes hot flushes, what they feel like, how long they tend to last, and what you can do to manage them.

What are hot flushes and what causes them?

Hot flushes are sudden episodes of intense heat, usually felt in the face, neck, and chest. They can cause sweating, red skin, a fast heartbeat, and sometimes chills, dizziness, or anxiety.

They happen because of hormone changes during menopause, especially when oestrogen levels drop. This affects the hypothalamus, the part of the brain that controls body temperature. It becomes too sensitive and thinks the body is overheating even when it isn’t.[2]

To cool down, the body:

• Widens blood vessels
• Increases sweating
• Speeds up the heartbeat

Brain chemicals like norepinephrine and serotonin also play a role. This is why some antidepressants can help reduce hot flushes.[3,4]

Hot flushes can happen during the day or at night (called night sweats) and may affect sleep and mood.

When do hot flushes start?

Hot flushes typically begin during perimenopause, the years leading up to menopause when hormone levels begin to fluctuate. This stage can start in your 40s or even earlier and is when many women first notice symptoms like irregular periods, mood changes, and night sweats. Hot flushes can continue into postmenopause, sometimes for several years after periods stop [5].

How do hot flushes feel?

Most women describe a hot flush as a sudden wave of heat that rises through the chest, neck, and face. Skin may redden or feel prickly, and sweating can follow. Episodes last from 30 seconds to several minutes. Some women experience a few flushes a week; others may have them hourly.

At night, they can cause night sweats, which disrupt sleep and contribute to fatigue, mood changes, and difficulty concentrating the next day [6].

How long do they last?

Hot flushes can last much longer than many people expect. One large study (the SWAN study) found that the average duration is around 7 years, but for some women, they may continue for over a decade [7].

What can help?

There is no single treatment that works for everyone, but several options are proven to help.

1. Hormone Replacement Therapy (HRT)

HRT is the most effective treatment for hot flushes. It replaces the oestrogen your body is no longer producing, helping to reduce the frequency and intensity of vasomotor symptoms (hot flushes and night sweats). For most healthy women under 60 or within 10 years of menopause, the benefits outweigh the risks [8].

2. Non-Hormonal Medications

Some women cannot or choose not to use HRT. Alternatives include:

• SSRIs and SNRIs (e.g. escitalopram, venlafaxine, paroxetine): can reduce flushes by affecting the brain’s thermoregulation pathways.
• Gabapentin: an anticonvulsant also shown to reduce hot flush frequency.
• Clonidine: a blood pressure medication that may help, though side effects limit its use.
• Fezolinetant: a new, non-hormonal treatment targeting neurokinin B receptors, shown to reduce flushes without hormonal activity [9,10].

3. Lifestyle and behavioural strategies

While not curative, these can help reduce triggers and manage symptoms:

• Dress in light layers and breathable fabrics
• Use fans or carry a cooling spray
• Avoid common triggers like spicy food, caffeine, alcohol, and stress
• Stay well hydrated
• Keep your environment cool, especially at night
• Practice paced breathing or mindfulness during a flush
• Exercise regularly and aim for a consistent sleep routine [11]

What helps naturally?

In addition to lifestyle strategies, some women find relief from:

• Cognitive behavioural therapy (CBT): shown to reduce the impact of flushes on quality of life
• Relaxation techniques like yoga, deep breathing, and meditation
• Plant-based options like isoflavones (e.g. from soy), though scientific evidence on their effectiveness is mixed [11]

When to seek help

Hot flushes are common, but that doesn’t mean you have to live with them. If they interfere with your sleep, your confidence, your concentration and your comfort it’s worth speaking to a menopause clinician.

There is no symptom "threshold" you need to meet. Help is available, whether your symptoms are mild or severe. Effective, personalised options exist.

The bottom line

Hot flushes are one of the hallmark symptoms of menopause. They are rooted in real physiological changes, not something to dismiss or just "push through." With the right approach, they can be managed, reduced, and in many cases, resolved.

References

^¹

1. Nappi, Rossella E., et al. "Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden." Menopause 28.8 (2021): 875-882. https://pmc.ncbi.nlm.nih.gov/articles/PMC8746897/

^²

1. Gombert-Labedens, Marie, et al. "Effects of menopause on temperature regulation." Temperature 12.2 (2025): 92-132. https://pmc.ncbi.nlm.nih.gov/articles/PMC12051537/

^³

1. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115-120. https://www.sciencedirect.com/science/article/abs/pii/S0960076013001532

^⁴

1. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975-4011. https://pubmed.ncbi.nlm.nih.gov/26444994/

^⁵

1. Harlow SD, Gass M, Hall JE, et al. Executive summary of Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159-1168. https://pubmed.ncbi.nlm.nih.gov/22344196/

^⁶

1. Baker, Fiona C., et al. "Sleep and sleep disorders in the menopausal transition." Sleep medicine clinics 13.3 (2018): 443. https://pmc.ncbi.nlm.nih.gov/articles/PMC6092036/

^⁷

1. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531-539. https://pmc.ncbi.nlm.nih.gov/articles/PMC4433164/

^⁸

1. Mehta, Jaya, Juliana M. Kling, and JoAnn E. Manson. "Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts." Frontiers in endocrinology 12 (2021): 564781. https://pmc.ncbi.nlm.nih.gov/articles/PMC8034540/

^⁹

1. Santoro N, Pinkerton JV, Bushmakin AG, et al. Effect of fezolinetant on moderate to severe vasomotor symptoms: a randomized clinical trial. JAMA. 2023;329(4):314-325. https://pubmed.ncbi.nlm.nih.gov/36734148/

^¹⁰

1. Lederman, Samuel, et al. "Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study." The Lancet 401.10382 (2023): 1091-1102. https://pubmed.ncbi.nlm.nih.gov/36924778/

^¹¹

1. NHS. Things you can do during the menopause. https://www.nhs.uk/conditions/menopause/things-you-can-do/

^¹²

1. Franco OH, Chowdhury R, Troup J, et al. Use of plant-based therapies and menopausal symptoms: a systematic review and meta-analysis. JAMA. 2016;315(23):2554-2563. https://jamanetwork.com/journals/jama/fullarticle/2529629